Reuters Health

Saturday, February 1, 2003

Fri January 31, 2003 05:25 PM ET

By Keith Mulvihill

NEW YORK (Reuters Health) - The majority of newborn brain injuries are not caused by problems during labor and delivery, according to a report released Friday that has been endorsed by medical experts from several major US organizations.

Most often cerebral palsy and brain swelling, known as encephalopathy, are the result of problems that occurred before labor, according to the report that was developed by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP).

Such conditions have been a major source of lawsuits against obstetricians, because many believe a lack of oxygen, or hypoxia, is the cause of the brain injury. As such, many assume that doctors and nurses could have prevented the devastating brain damage, explained Dr. Gary D. V. Hankins, the chair of the task force at ACOG that developed the report.

"A lot of myth surrounds the of infant encephalopathy and cerebral palsy," said Hankins, who is at the University of Texas Medical Branch in Galveston.

Cerebral palsy is a neurological disorder that leads to delayed walking, exaggerated reflexes, spastic movements and impaired speech, vision and hearing. The disorder is more common in premature infants and occurs in 2 to 3 of every 1,000 births.

Neonatal encephalopathy, on the other hand, is a type of brain damage associated with inflammation, or swelling of the brain. It may or may not result in permanent neurological problems.

The task force evaluated the latest scientific evidence on encephalopathy and cerebral palsy and updated a 1999 consensus statement by an International Cerebral Palsy Task Force, which was published in the British Medical Journal.

The main finding of the report, according to Hankins, is that lack of oxygen during labor or delivery is not a significant cause for the majority of cases of encephalopathy or cerebral palsy.

In fact, there is evidence of an insufficient oxygen supply in fewer than one in four cases of infant encephalopathy. In 70% of infant encephalopathy cases, data suggest that another underlying event that takes place before labor and delivery is the more probable cause for the condition.

The report has been endorsed by several leading government health agencies including the National Institutes of Health and the Centers for Disease Control and Prevention, which should lend an additional level of credibility to the report, Hankins said during an interview with Reuters Health.

"The document has been reviewed by over 200 doctors from the US and abroad...making it one of the most highly peer reviewed reports ever," said Hankins.

"I would hate to see people twist the meaning behind the study...this is not a case of doctors trying to cover themselves," he said, referring to the numerous malpractice suits linked to cerebral palsy or encephalopathy.

"The United Cerebral Palsy Research (and Education) Foundation concurs with the findings of the report," said the organization's medical director, Dr. Murray Goldstein, during a telephone interview from his office in Washington, DC.

Goldstein explained that in 70% of the cases of cerebral palsy, brain damage occurs due to events prior to labor and delivery, 20% of the cases are caused by brain damage events that happen during labor, delivery and immediately following birth and 10% of the cases result from brain damage incurred during the first two years of life.

"For years, adverse neurologic outcomes of pregnancy, including cerebral palsy and neonatal encephalopathy, have been assumed to be the effect of events occurring during childbirth," said ACOG President Dr. Charles B. Hammond, in a prepared statement. "In the face of a bad outcome, many faulted ob-gyns. We now know that less than 10% of cases of neurologic impairment in newborns are the result of events occurring in labor and, of these, the majority were not preventable."

The report has also been endorsed by the March of Dimes Birth Defects Foundation, the Society for Maternal and Fetal Medicine, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada.